静脉注射美托洛尔治疗室上性心动过速疗效观察

目的 评价静脉注射美托洛尔终止室上性心动过速（SVT）发作的疗效及安全性。方法 将我院门诊就诊或住院治疗的66例SVT患者,随机分成美托洛尔组（30例）和胺碘酮组（36例）,两组分别缓慢静脉注射美托洛尔或胺碘酮,比较终止SVT的有效率及不良反应。结果 美托洛尔组治疗后显效17例、有效4例,无效9例,有效率70．0％;胺碘酮组治疗后有显著效果18例、有效5例,无效13例,有效率63．9％,关托洛尔和胺碘酮两组治疗SVT的疗效比较,差异无统计学意义（P=0．572）。未观察到美托洛尔或胺碘酮组治疗后有明显的不良反应。结论 美托洛尔是一种安全的、比较有效的终止SVT的药物。     

Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia.

Two cases of paroxysmal supraventricular tachycardia are reported in which the administration of adenosine produced sustained elevation of the rate of paroxysmal supraventricular tachycardia. In each case, sinus rhythm was restored readily through the use of intravenous verapamil. This adverse reaction to adenosine has not been previously described.     

Hospitalization rate of paroxysmal supraventricular tachycardia in Sweden

Abstract

Introduction: The hospitalization rate of paroxysmal supraventricular tachycardia (PSVT) in a nationwide study is not established. We determined age- and sex-specific hospitalization rates and time trends for hospitalized PSVT in the Swedish population between 1987 and 2010.

Methods: This nationwide study is based on the Swedish Hospital Discharge Register. The patients with first PSVT diagnoses between January 1987 and December 2010 were identified.

Results: A total of 42,765 individuals with PSVT were diagnosed (mean age 60 years; 44% males). The overall age- and sex-adjusted hospitalization rate was 20 per 100,000 person-years. The hospitalization rate increased with advancing age with highest hospitalization rates in individuals aged 80–84 years (67.12 per 100,000 person-years) and did not change significantly over time. A total of 20,011 (46.8%) patients had “lone” PSVT without any comorbidities. Lone PSVT patients were younger than PSVT patients with comorbidities (mean age 54 vs. 67 years, p?=?.0002).

Conclusions: This study showed a slight preponderance for females and stable hospitalization rate of PSVT over time; the hospitalization rate increased with age. A high proportion of PSVT patients had no comorbidities. They were affected at a younger age than patients with comorbidities, which suggests an inherent predisposition.

• Key messages

• This study represents the first extensive and nationwide hospitalization study of PSVT. Hospitalization is highest in old age but a bimodal pattern was observed with a small peak in the first years of life. Patients with lone PSVT are younger than those with comorbidities; which suggests an inherent predisposition.

     

普罗帕酮终止阵发性室上性心动过速疗效观察

目的观察普罗帕酮(心律平)终止阵发性室上性心动过速(PSVT)的即时疗效及安全性.方法37例PSVT,静脉注射普罗帕酮70mg,于5分钟完成,观察20分钟;未终止者重复用70mg,再观察30分钟,仍未终止者再用70mg.用药前、后和PSVT终止时,记录血压、心率及12导联心电图.结果显效75.7%(28/37),有效21.6%(8/37),总有效率97.3%.起效时间1～55(7.1±2.8)分钟.普罗帕酮平均累积量105mg.部分患者可出现轻度血压下降,P-R间期、QRS时限及QTc间期延长,一过性Ⅱ度Ⅰ型窦房阻滞及头晕、恶心等副作用,未经处理逐渐消失.结论普罗帕酮静脉注射终止PSVT有效、快速、安全.     

Clinical effectiveness of ethacizine in the treatment of supraventricular paroxysmal tachycardia

I. v. administration of ethacizine was used in 2 cases of spontaneous and 15 cases of induced SV arrhythmic paroxysm. Induction was based on rapid left atrial transesophageal pacing. In addition to external leads esophageal leads were also recorded. The drug was injected at a dose of 50-100 mg. The effect was achieved in 18 (94.7%) and lasted 3-10 min. AV recurrent tachycardia was stopped as a result of blockade in the AV node in anterograde or retrograde direction, in orthodromic tachycardia--as a result of impulse conduction blockade via accessory conductive tract, and in cases of antidromic--as a result of retrograde blockade in the AV node. Among the most serious side-effects was ventricular tachycardia.     

盐酸普罗帕酮治疗阵发性室上性心动过速的疗效观察

阵发性室上性心动过速,是临床较常见的心律失常,可出现于有或无器质性心脏病病人,常呈阵发性发作,发作时因心排血量下降可伴有胸闷、头晕等症状,或原有器质性心脏病加重而危及生命.因此及时复转阵发性室上性心动过速(PSVT),改善或消除其导致的一系列临床症状极为重要.目前治疗措施有药物复转、电复转和根治性射频消融.其中盐酸普罗帕酮(心律平)能有效地终止大多数病例的PSVT,但也有报道其致心律失常,特别是心肌缺血易诱发致命性室性心律失常[1].本文选用心律平治疗阵发性室上性心动过速22例,取得了较好效果.现报告如下.……     

盐酸普罗帕酮治疗阵发性室上性心动过速的疗效观察

阵发性室上性心动过速，是临床较常见的心律失常，可出现于有或无器质性心脏病病人，常呈阵发性发作，发作时因心排血量下降可伴有胸闷、头晕等症状，或原有器质性心脏病加重而危及生命。因此及时复转阵发性室上性心动过速（PSVT），改善或消除其导致的一系列临床症状极为重要。目前治疗措施有药物复转、电复转和根治性射频消融。其中盐酸普罗帕酮（心律平）能有效地终止大多数病例的PSVT，但也有报道其致心律失常。特别是心肌缺血易诱发致命性室性心律失常。本文选用心律平治疗阵发性室上性心动过速22例，取得了较好效果。现报告如下。     

High-dose adenosine for treatment of refractory paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia (PSVT) is one of the more common arrhythmias requiring treatment in the emergency department. Intravenous adenosine is recommended as the initial medication of choice for treatment of PSVT, given in escalating doses up to a maximum of 12 mg. With a serum half-life of less than 10 s, adenosine must be given rapidly to allow for adequate time for it to reach the heart via venous return. In over 10% of adult patients, PSVT will not be terminated with maximum doses of adenosine. We report a case of a patient requiring a higher-than recommended dose of adenosine for termination of PSVT. The patient had a history of pulmonary hypertension with resultant right heart failure at the time of presentation. We believe the higher dose of adenosine was necessary in this patient because of the impaired venous return to her right heart. This case indicates that patients with impaired venous return to the right heart may require higher-than-recommended doses of adenosine for effective termination of PSVT.     

Atresia of the coronary sinus in patients with supraventricular tachycardia

Background: Atresia of the coronary sinus (CS) ostium with retrograde drainage of the cardiac veins via the persistent left superior vena cava (PLSVC) is a rare abnormality and only a few case reports in association with electrophysiological studies have been reported.
Methods: During standard electrophysiological study in three patients with a focal left atrial tachycardia, atrial fibrillation and common type right atrial flutter, the CS could not be cannulated despite several attempts. Assuming an occluded CS ostium we advanced a multipurpose catheter via the right atrium and the right superior vena cava in a PLSVC and performed CS angiography.
Results: CS angiography showed that the CS was occluded in all 3 patients and the PLSVC was used as a drainage route to the superior vena cava. After retrograde placement of a 2.5 Fr nonsteerable diagnostic catheter via the PLSVC in the CS, the intracardiac CS electrogram was recorded. Successful ablation could be performed in all three cases.
Conclusions: The cases highlight the possibility that failure to access the CS during electrophysiological studies may be related to this anomaly and that retrograde cannulation via PLSVC enables the CS access and acquisition of its electrograms.     

Treatment of paroxysmal supraventricular tachycardia with oral diltiazem.

Symptomatic paroxysmal supraventricular tachycardia is a troubling arrhythmia for many patients. To test the efficacy of oral diltiazem to reduce symptomatic recurrences of paroxysmal supraventricular tachycardia, we enrolled 17 patients in a double-blind, placebo-controlled crossover study. Sixteen of 17 patients completed a dose-ranging phase and were entered into the randomized phase. Although the time to first recurrence of tachycardia was slightly longer when patients took diltiazem, the difference was not significant (p = 0.15). The hazard ratio of the time to first recurrence on placebo compared with oral diltiazem was 2.7 (95% confidence interval, 0.8 to 9.1). Of the patients who had a recurrence of tachycardia in both treatment periods, the median reduction in heart rate in patients receiving diltiazem was 20 beats/min. (p less than 0.01; 95% confidence interval, 6 to 42).     

aVR导联在阵发性室上性心动过速中的鉴别诊断价值

目的分析心电图aVR导联形态在阵发性室上性心动过速中的鉴别诊断价值。方法选取泰达国际心血管病医院行射频消融的室上性心动过速患者157例,男69例,女88例,年龄13~74岁,平均（41.9±19.2）岁,以心内电生理检查结果为金标准,分为慢快型房室结折返性心动过速组（SF-AVNRT组,n=89）和左侧房室旁路参与的房室折返性心动过速组（AVRT组,n=68）,入选者在窦性心律和室上性心动过速时无束支传导阻滞。结果与窦性心律时相比,SF-AVNRT组aVR导联QRS波终末部形态改变（假性r波或粗顿）的发生率73.0%,AVRT组aVR导联QRS波终末部形态改变（假性r波或粗顿）的发生率为1.5%,差异有统计学意义（P〈0.01）;与窦性心律时相比,SF-AVNRT组aVR导联ST段抬高、水平型移行或T波降支切迹的发生率为2.2%,AVRT组aVR导联ST段抬高、水平型移行或T波降支切迹的发生率为89.7%,差异有统计学意义（P〈0.05）。结论与窦性心律时相比,SF-AVNRT和AVRT在aVR导联具有不同的心电图特点,aVR导联QRS波终末部形态和ST段形态对判断室上性心动过速的类型具有重要意义,需高度重视aVR导联在室上性心动过速中的鉴别诊断价值。     

咽部冷刺激对阵发性室上性心动过速的疗效

目的 分别结合冷刺激咽部反射及机械刺激咽部反射对阵发性室上性心动过速（PSVT）的疗效比较。方法对我院急诊接诊的89例阵发性室上速随机分成冷刺激咽部反射A组,机械刺激咽部反射B组,每组均予维拉帕米5～10mg（0．075mg／kg）静脉注射。结果两组阵发性室上性的治疗效果差异有统计学意义（P〈0．05）,A组较B组转复率高,且快速有效。结论冷刺激咽部反射治疗PSVT比机械刺激组有效,同时降低了异搏定用量。     

Treatment of supraventricular paroxysmal tachycardia by intravenous administration of ATP

The results of treatment of supraventricular paroxysmal tachycardia by the intravenous administration of ATP in a dose of 10-30 mg make it possible to consider ATP as an agent of choice for relieving supraventricular paroxysmal tachycardia under conditions of emergency medical aid.